Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $8.64 / $12.96 / $15.63	Facility	26	$8.64	$12.96	$15.63
Aetna Facility/Professional Professional Modifier Low / Median / High Price $51.91 / $58.97 / $120.70	Professional		$51.91	$58.97	$120.70
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.07 / $9.26 / $23.30	Professional	26	$8.07	$9.26	$23.30
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $24.67 / $28.78 / $39.04	Professional	52	$24.67	$28.78	$39.04
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $42.95 / $49.36 / $76.50	Professional	TC	$42.95	$49.36	$76.50
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $45.77 / $51.50 / $67.81	Professional		$45.77	$51.50	$67.81
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $7.55 / $9.27 / $11.92	Professional	26	$7.55	$9.27	$11.92
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $38.40 / $42.21 / $60.44	Professional	TC	$38.40	$42.21	$60.44
BCBS Facility/Professional Professional Modifier Low / Median / High Price $9.78 / $32.13 / $96.03	Professional		$9.78	$32.13	$96.03
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $10.06 / $10.06 / $10.06	Facility	26	$10.06	$10.06	$10.06
Cigna Facility/Professional Professional Modifier Low / Median / High Price $54.84 / $75.79 / $114.69	Professional		$54.84	$75.79	$114.69
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $8.83 / $11.92 / $18.89	Professional	26	$8.83	$11.92	$18.89
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $46.00 / $63.81 / $96.11	Professional	TC	$46.00	$63.81	$96.11
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $55.44 / $80.64 / $326.70	Professional		$55.44	$80.64	$326.70
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $8.92 / $13.01 / $53.42	Professional	26	$8.92	$13.01	$53.42
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $45.97 / $66.23 / $272.42	Professional	TC	$45.97	$66.23	$272.42
Hally Health Facility/Professional Facility Modifier 26 Low / Median / High Price $100.00 / $100.00 / $100.00	Facility	26	$100.00	$100.00	$100.00
Hally Health Facility/Professional Professional Modifier Low / Median / High Price $65.52 / $67.42 / $72.98	Professional		$65.52	$67.42	$72.98
Hally Health Facility/Professional Professional Modifier 26 Low / Median / High Price $10.54 / $10.87 / $11.48	Professional	26	$10.54	$10.87	$11.48
Hally Health Facility/Professional Professional Modifier TC Low / Median / High Price $54.65 / $56.88 / $61.50	Professional	TC	$54.65	$56.88	$61.50
Molina Facility/Professional Professional Modifier Low / Median / High Price $12.01 / $32.34 / $70.97	Professional		$12.01	$32.34	$70.97
United Facility/Professional Professional Modifier Low / Median / High Price $49.81 / $68.40 / $110.00	Professional		$49.81	$68.40	$110.00
United Facility/Professional Professional Modifier 26 Low / Median / High Price $8.11 / $10.47 / $18.07	Professional	26	$8.11	$10.47	$18.07
United Facility/Professional Professional Modifier TC Low / Median / High Price $41.92 / $57.52 / $93.89	Professional	TC	$41.92	$57.52	$93.89